Skip to main content

Advertisement

SpringerLink
Log in

Differential Service Utilization Associated With Trauma-informed Integrated Treatment for Women With Co-occurring Disorders

  • Original Paper
  • Published:
Administration and Policy in Mental Health and Mental Health Services Research Aims and scope Submit manuscript

Abstract

Women with co-occurring mental health and substance use disorders and trauma histories vary greatly in symptom severity and use of support services. This study estimated differential effects of an integrated treatment intervention (IT) across sub-groups of women in this population on services utilization outcomes. Data from a national study were used to cluster participants by symptoms and service utilization, and then estimate the effect of IT versus usual care on 12-month service utilization for each sub-group. The intervention effect varied significantly across groups, in particular indicating relative increases in residential treatment utilization associated with IT among women with predominating trauma and substance abuse symptoms. Understanding how IT influences service utilization for different groups of women in this population with complex needs is an important step toward achieving an optimal balance between need for treatment and service utilization, which can ultimately improve outcomes and conserve resources.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  • Alexander, M. J. (1996). Women with co-occurring addictive and mental disorders: An emerging profile of vulnerability. American Journal of Orthopsychiatry, 66(1), 61–70.

    Article  PubMed  CAS  Google Scholar 

  • Andersen, R. M. (1995). Revisiting the behavioral model and access to medical care: Does it matter? Journal of Health and Social Behavior, 36(1), 1–10.

    Article  PubMed  CAS  Google Scholar 

  • Barnett, P. G., & Swindle, R. W. (1997). Cost-effectiveness of inpatient substance abuse treatment. Health Services Research, 32(5), 615–629.

    PubMed  CAS  Google Scholar 

  • Becker, M. A., Noether, C. D., Larson, M. J., Gatz, M., Brown, V., Heckman, J. P., et al. (2005). Characteristics of women engaged in treatment for trauma and co-occurring disorders: findings from a national multisite study. Journal of Community Psychology, 4(33), 429–443.

    Article  Google Scholar 

  • Chen, S., Barnett, P. G., Sempel, J. M., & Timko, C. (2006). Outcomes and costs of matching the intensity of dual-diagnosis treatment to patients’ symptom severity. Journal of Substance Abuse Treatment, 31(1), 95–105.

    Article  PubMed  Google Scholar 

  • Clark, R. E., Samnaliev, M., & McGovern, M. P. (2007). Treatment for co-occurring mental and substance use disorders in five state Medicaid programs. Psychiatric Services, 58, 942–948.

    Article  PubMed  Google Scholar 

  • Cocozza, J. J., Jackson, E., Hennigan, K., Morrissey, J. P., Reed, B. G., Fallot, R., et al. (2005). Outcomes for women with co-occurring disorders and trauma: Program-level effects. Journal of Substance Abuse Treatment, 28(2), 109–119.

    Article  PubMed  Google Scholar 

  • Cusack, K. J., Morrissey, J. P., & Ellis, A. R. (2008). Targeting trauma-related interventions and improving outcomes for women with co-occurring disorders. Administration and Policy in Mental Health, 35(3), 147–158.

    Article  PubMed  Google Scholar 

  • Derogatis, L. (1993). A brief form of the SCL-90-R: A self-report symptom inventory designed to measure psychological stress: Brief system inventory (BSI). Minneapolis: National Computer Systems.

    Google Scholar 

  • Dickey, B., & Azeni, H. (1996). Persons with dual diagnoses of substance abuse and major mental illness: Their excess costs of psychiatric care. American Journal of Public Health, 86(7), 973–977.

    Article  PubMed  CAS  Google Scholar 

  • Domino, M. E., Morrissey, J. P., Chung, S., Huntington, N., Larson, M. J., & Russell, L. A. (2005a). Service use and costs for women with co-occurring mental and substance use disorders and a history of violence. Psychiatric Services, 56(10), 1223–1232.

    Article  PubMed  Google Scholar 

  • Domino, M. E., Morrissey, J. P., Chung, S., & Nadlicki, T. (2006). Changes in service use during a trauma-informed intervention for women. Women and Health, 44(3), 105–122.

    Google Scholar 

  • Domino, M., Morrissey, J. P., Nadlicki-Patterson, T., & Chung, S. (2005b). Service costs for women with co-occurring disorders and trauma. Journal of Substance Abuse Treatment, 28(2), 135–143.

    Article  PubMed  Google Scholar 

  • Drake, R. E., Mueser, K. T., Brunette, M. F., & McHugo, G. J. (2004). A review of treatments for people with severe mental illnesses and co-occurring substance abuse disorders. Psychiatric Rehabilitation Journal, 27(4), 360–374.

    Article  PubMed  Google Scholar 

  • Foa, E. (1995). Posttraumatic stress diagnostic scale manual. Minneapolis: National Computer Systems.

    Google Scholar 

  • Foa, E., Cashman, L., Jaycox, L., & Perry, K. (1997). The validation of a self-report measure of posttramatic stress disorder: The posttraumatic diagnostic scale. Psychological Assessment, 9, 445–451.

    Article  Google Scholar 

  • Fullilove, M. T., Fullilove, R. E., Smith, M., Winkler, K., Michael, C., Panzer, P. G., et al. (1993). Violence, trauma, and post-traumatic stress disorder among women drug users. Journal of Traumatic Stress, 6(4), 533–543.

    Article  Google Scholar 

  • Gearon, J. S., Kaltman, S. I., Brown, C., & Bellack, A. S. (2003). Traumatic life events and PTSD among women with substance use disorders and schizophrenia. Psychiatric Services, 54(4), 523–528.

    Article  PubMed  Google Scholar 

  • Goldberg, D., & Huxley, P. (1980). Mental illness in the community: the pathway to psychiatric care. New York: Tavistock Publications, Ltd.

    Google Scholar 

  • Goodman, L. A., Rosenberg, S. D., Muese, K., & Drake, R. E. (1997). Physical and sexual assault history in women with serious mental illness: Prevalence, correlates, treatment, and future research directions. Schizophrenia Bulletin, 23(4), 685–696.

    Article  PubMed  CAS  Google Scholar 

  • Goodman, L. A., Salyers, M. P., Mueser, K. T., Rosenberg, S. D., Swartz, M., Essock, S. M., et al. (2001). Recent victimization in women and men with severe mental illness: Prevalence and correlates. Journal of Traumatic Stress, 14, 615–632.

    Article  PubMed  CAS  Google Scholar 

  • Greenfield, L., Burgdorf, K., Chen, X., Porowski, A., Roberts, T., & Herrell, J. (2004). Effectiveness of long-term residential substance abuse treatment for women: Findings from three national studies. American Journal of Drug and Alcohol Abuse, 30(3), 537–550.

    Article  PubMed  Google Scholar 

  • Hanson, T., Hesselbrock, M., Tworkowski, S. H., & Swan, S. (2002). The prevalence and management of trauma in the public domain: An agency and clinician perspective. The Journal of Behavioral Health Services & Research, 29, 365–380.

    Article  Google Scholar 

  • Harris, M. (1994). Modifications in service delivery and clinical treatment for women diagnosed with severe mental illness who are also the survivors of sexual abuse trauma. Journal of Mental Health Administration, 21(4), 397–406.

    Article  PubMed  CAS  Google Scholar 

  • Harris, K. M., & Edlund, M. J. (2005). Use of mental health care and substance abuse treatment among adults with co-occurring disorders. Psychiatric Services, 56(8), 954–959.

    Article  PubMed  Google Scholar 

  • Kessler, R. C., Crum, R. M., Warner, R. A., Nelson, C. B., Schlenberg, J., & Anthony, J. C. (1997). Lifetime co-occurrence of DSM III-R alcohol abuse and dependence with other psychiatric disorders in the national comorbidity survey. Archives of General Psychiatry, 54, 313–321.

    Article  PubMed  CAS  Google Scholar 

  • Keyser, D. J., Watkins, K. E., Vilamovska, A., & Pincus, H. A. (2008). Improving service delivery for individuals with do-occurring disorders: New perspectives on the quadrant model. Psychiatric Services, 59, 1251–1253.

    Article  PubMed  Google Scholar 

  • Khattree, R., & Naik, D. (1999). Multivariate data reduction and discrimination with SAS software. Cary: SAS Institute, Inc.

    Google Scholar 

  • Larkin, S. (2007). Origins of the quadrant model for persons with co-occurring disorders. Psychiatric Services, 58(12), 1607–1608.

    Article  PubMed  Google Scholar 

  • Larson, M. J., Miller, L., Becker, M., Richardson, E., Kammerer, N., Thom, J., et al. (2005). Physical health burdens of women with trauma histories and co-occurring substance abuse and mental disorders. The Journal of Behavioral Health Services & Research, 32(2), 128–140.

    Article  Google Scholar 

  • Manski, C. F. (2001). New developments in evaluating social programs. The American Economic Review, 91(2), 103–106.

    Article  Google Scholar 

  • McGovern, M. P., Clark, R. E., & Samnaliev, M. (2007). Co-occurring psychiatric and substance use disorders: A multistate feasibility study of the quadrant model. Psychiatric Services, 58, 949–954.

    Article  PubMed  Google Scholar 

  • McHugo, G. J., Kammerer, N., Jackson, E. W., Markoff, L. S., Gatz, M., Larson, M. J., et al. (2005). Women, co-occurring disorders, and violence study: Evaluation design and study population. Journal of Substance Abuse Treatment, 2, 91–107.

    Article  Google Scholar 

  • McLellan, A. T., Kushner, J., Metzger, D., Peters, R., Smith, I., Grissom, G., et al. (1992). The fifth edition of the Addiction Severity Index. Journal of Substance Abuse Treatment, 9(3), 199–213.

    Article  PubMed  CAS  Google Scholar 

  • McLellan, A. T., Woody, G., & Metzger, D. (1996). Evaluating the effectiveness of addiction treatments: Reasonable expectations, appropriate comparisons. The Milbank Quarterly, 74, 51–85.

    Article  PubMed  CAS  Google Scholar 

  • Milligan, G. W. (1980). An examination of the effect of six types of error perturbation on fifteen clustering algorithms. Psychometrika, 45, 325–342.

    Article  Google Scholar 

  • Milligan, G. W., & Cooper, M. C. (1985). An examination of procedures for determining the number of clusters in a data set. Psychometrika, 50, 159–179.

    Article  Google Scholar 

  • Milligan, G. W., & Cooper, M. C. (1988). A study of standardization of variables in cluster analysis. Journal of Classification, 5, 181–204.

    Article  Google Scholar 

  • Morrissey, J. P., Ellis, A. R., Gatz, M., Amaro, H., Reed, B. G., Savage, A., et al. (2005a). Outcomes for women with co-occurring disorders and trauma: Program and person-level effects. Journal of Substance Abuse Treatment, 28(2), 21–33.

    Article  Google Scholar 

  • Morrissey, J. P., Jackson, E. W., Ellis, A. R., Amaro, H., Brown, V. B., & Najavits, L. (2005b). Twelve-month outcomes of trauma-informed interventions for women with co-occurring disorders. Psychiatric Services, 56(10), 213–222.

    Article  Google Scholar 

  • Mueser, K. T., Goodman, L. B., Trumbetta, S. L., Rosenberg, S. D., Osher, C., Vidaver, R., et al. (1998). Trauma and posttraumatic stress disorder in severe mental illness. Journal of Consulting and Clinical Psychology, 66(3), 493–499.

    Article  PubMed  CAS  Google Scholar 

  • Najavits, L. M., Weiss, R. D., & Shaw, S. R. (1997). The link between substance abuse and post-traumatic stress disorder in women: A research review. The American Journal of Addictions/American Academy of Psychiatrists in Alcoholism and Addictions, 6, 273–283.

    CAS  Google Scholar 

  • Najavits, L. M., Weiss, R. D., Shaw, S. R., & Muenz, L. R. (1998). Seeking safety: Outcome of a new cognitive-behavioral psychotherapy for women with posttraumatic stress disorder and substance abuse. Journal of Trauma Stress, 11(3), 437–456.

    Article  CAS  Google Scholar 

  • National Association of the State Mental Health Program Directors & National Association of State Alcohol and Drug Abuse Directors. (1998). National dialogue on co-occurring mental health and substance abuse disorders. Retrieved from www.nasadad.org/Departments/Research/ConsensusFramework/national_dialogue_on.htm.

  • Roebuck, M. C., French, M. T., & McLellan, A. T. (2003). DATStats: Results from 85 studies using the Drug Abuse Treatment Cost Analysis Program (DATCAP). Journal of Substance Abuse Treatment, 25, 51–57.

    Article  PubMed  Google Scholar 

  • Shrout, P. E. (1998). Measurement reliability and agreement in psychiatry. Statistical Methods in Medical Research, 7, 301–317.

    Article  PubMed  CAS  Google Scholar 

  • Substance Abuse and Mental Health Services Agency, US Department of Health and Human Services. (2002). Report to Congress on the prevention and treatment of co-occurring substance abuse disorders and mental disorders.

  • Watkins, K. E., Burnam, A., Kung, F. Y., & Paddock, S. (2001). A national survey of care for persons with co-occurring mental health and substance abuse disorders. Psychiatric Services, 52(8), 1062–1068.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, DUMC Box 3071, Durham, NC, 27710, USA

    Allison R. Gilbert

  2. Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Marisa E. Domino

  3. Departments of Health Policy and Management and Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Joseph P. Morrissey

  4. Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Joseph P. Morrissey

  5. Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Bradley N. Gaynes

Authors
  1. Allison R. Gilbert
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marisa E. Domino
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Joseph P. Morrissey
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Bradley N. Gaynes
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Allison R. Gilbert.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gilbert, A.R., Domino, M.E., Morrissey, J.P. et al. Differential Service Utilization Associated With Trauma-informed Integrated Treatment for Women With Co-occurring Disorders. Adm Policy Ment Health 39, 426–439 (2012). https://doi.org/10.1007/s10488-011-0362-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10488-011-0362-z

Keywords

Search

Navigation